The Care Quality Commission
  • Mental Health
  • Independent mental health service

Archived: Bestwood

Overall: Requires improvement read more about inspection ratings

401 Bestwood Road, Bestwood Village, Nottingham, Nottinghamshire, NG6 8UA (0115) 979 4621

Provided and run by:
Eden Supported Living Limited

All Inspections

30 JUNE 2016

During a routine inspection

We rated this service as requires improvement because:

  • Staff did not update care plans regularly enough and although care plans did show some patient involvement they did not show the plans had been developed in a collaborative way. This meant changes in care may not be carried out correctly and patients may not have discussed choices about how their care is given. Staff were in the process of reviewing care plans in accordance with the new owner, St Andrews policies and procedures.
  • Patients did not have enough meaningful activities, which meant the patients were not being prepared sufficiently for a move into the community.
  • Staff had not received regular supervision.
  • Not all staff had completed mandatory training and the uptake of specialist training was low.
  • Staff had not received training in the Mental Health Act, although staff showed a good understanding of their responsibilities.
  • Not all staff had undertaken Mental Capacity Act training.
  • Staff did not review capacity and consent assessments for day to day decision making.
  • The provider did not involve patients and staff with the running of the service.
  • There were no patient or staff surveys, or community meetings to gain feedback on patient care provided by the previous provider.
  • There had been no community meetings or surveys to assess any patient feedback around their care provided by the previous provider.
  • There were no easy read information leaflets about patients’ rights, or information on how to complain on display.
  • The use of stable doors on the flat entrances created confusion over whether the patient was secluded, segregated or being observed.

However:

  • At the time of the inspection a new provider, St Andrews, had been managing the service for a month. Although there was more still to do, it was evident the provider had introduced many positive changes. The changes introduced had only recently been implemented and did not affect the ratings in this report.
  • Carers said they were involved and felt staff kept them informed.
  • Patients said nurses treated them in a caring way, with respect and dignity.
  • St Andrews senior management staff had visited the hospital and staff had visited other locations within the organisation.
  • There were enough staff to meet patient needs and services kept patients ‘safe from avoidable harm’.
  • Staff felt positive about the new provider St Andrews and reported an increase in morale.

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27 February 2015

During a routine inspection

Bestwood hospital provides care for six patients. The patients have complex needs, some of them have limited verbal communication and half of the patients do not have regular contact from family or friends. They live in their own apartments.

We found there was poor leadership because the management had no clear processes of checking whether safe practice was happening due to lack of ways to monitor performance. Audits had not been carried out. There was no monitoring of whether lessons learnt had been put into practice. The staff had not been provided with any performance monitoring information. Staff supervision, appraisals and team meetings were not occurring regularly. There was no formal risk register. There was an action plan that the hospital had in place, it did not identify the risks and lacked structure. The staff team did not have any team objectives to help them improve practice or work towards the vision and values of the hospital.

Not all staff were trained in using the ligature cutters and defibrillation in an emergency. Staff did report incidents and safeguarding's. Due to the lack of monitoring systems we were not assured that all incidents that should have been reported were.

There was lack of space for storage. There were limited facilities to encourage patients to have a choice of meeting up for activities and lack of staff meeting rooms. This meant that equipment such as mops were stored outside; medication was split between patient’s apartments and the clinical room. It also meant that the staff hub, a small communal area was noisy. The noise affected a patient who required a quiet and calm environment. Psychology and psychotherapy were undertaken in the patient's own apartment. This was not always the best place for patient's to talk about difficult issues and leave it behind.

There was a lack of activities for patients and this was affected by the lack of transport available to take them out into the community. There was minimal occupational therapy (OT) input to support rehabilitation.

Staff were not aware of patients' ability to read and write. Communication profiles were either not in place or the plans lacked detailed information. This meant that assessments were not thorough about individual needs and the plans that would support them. Information was not available to patients in an easy to understand format. There were no other ways of communication used to help patients understand information given to them.

The psychiatrist, speech and language therapist (SALT) and psychologist were employed for  two sessions per week. This meant there was little time available to undertake weekly reviews of all patients and work with individual patients. Support workers were not involved in the clinical team meetings. Support staff were not clear about what they should do to carry out the plans following clinical meetings or psychotherapy sessions with patients.

There were restrictive practices in place in which stable doors were kept locked by staff and opened following a nurse’s decision.

Patients did not have copies of their care plans. Care plans were not focused on recovery and there was little recording of discharge planning.

Some patients had limited verbal communication and were not able to tell us in detail what they thought about the care. They did not give any negative comments. Carers were satisfied with the care, although some found the travel from out of the area difficult and others were concerned about the lack of activities. Staff were caring and committed.

Staff did not have an understanding of the MCA and DoLS and how and when this applied to people who were detained under the MHA.

There was no management overview of whether safe practice was occurring due to the lack of performance monitoring.

We issued a warning notice relating to regulation 17 HCSA (RA) 2014 good governance.

20 May 2013

During a routine inspection

We spoke to one of the three people living at the hospital; another did not wish to speak to us and we spoke with the advocate of the third person who also acted as their independent mental health advocate (IMHA).

The person we spoke with felt the staff encouraged and enabled their decision making. The person said, "The staff explain things to me so I understand and can make decisions. We found the staff acted appropriately when they suspected people may lack capacity and protected their rights.

People had their care and welfare needs met well. The person we spoke with told us they had not seen their care plan, but they felt cared for and supported by the staff. The advocate told us the care plans were accurate and as up to date as possible, she told us people seemed very happy with the care they received.

People were protected from the risk of harm or abuse and said they felt safe at the service.

We found that the staff received training and supervision to help them understand the needs of people living at the service. A person told us, "It's alright here, they look after us, I like my keyworker. The staff are nice, I think they understand us. They help me cope."